Short-term outcome after total elbow arthroplasty in dogs with severe, naturally occurring osteoarthritis

OBJECTIVE: To evaluate limb function in client-owned dogs before and after total elbow arthroplasty (TEA) for severe, naturally occurring osteoarthritis (OA). STUDY DESIGN: Prospective clinical evaluation comparing limb function before and after surgery. ANIMALS: Twenty adult, large breed dogs with elbow OA. METHODS: Physical, radiographic, and force platform gait examinations were performed on all dogs before surgery. TEA was performed, and examinations were repeated at 3, 6, and 12 months after surgery. Pre- and postoperative findings were compared. RESULTS: TEA led to a satisfactory outcome in 16 dogs. In dogs with a satisfactory outcome, function in the operated limb increased over time, with mean peak vertical force (PVF) and vertical impulse (VI) 1 year after surgery being nearly twice the presurgical value. Serious complications encountered included infection (n = 2), luxation (n = 1), and fracture of the humeral condyle (n = 1). CONCLUSIONS: Although TEA, as presented, has significant limitations, it can be successfully performed in dogs with naturally occurring elbow OA. Improvements in technique and implant design should lead to improved prognosis. CLINICAL RELEVANCE: Based on 1-year data, TEA can be successfully performed in dogs and should be considered as a treatment alternative for adult dogs with lameness from severe OA of the elbow joint.     

Compensatory load redistribution in naturally occurring osteoarthritis of the elbow joint and induced weight-bearing lameness of the forelimbs compared with clinically sound dogs

The current study investigated the compensatory load redistribution due to osteoarthritis of the elbow joint using ground reaction forces of all four legs, simultaneously measured on a treadmill with integrated force plates. Three groups of dogs were used: the first group was clinically sound; the second group suffered from a naturally occurring osteoarthritis of the elbow joint, and a reversible lameness was induced in the third group. The naturally occurring osteoarthritis resulted in a compensatory gait pattern to reduce the stress on the affected limb. The load was reduced on the lame limb and increased on the contralateral hindlimb. The symmetry index indicated a weight-shift to the contralateral forelimb and diagonal hindlimb, which resulted in a more balanced weight distribution than in normal dogs. Dogs with induced lameness showed comparable but less pronounced alterations. These results suggested that forelimb lameness could lead to overload on non-affected extremities and the vertebral spine.     

Effect of dorsal hip loading,sedation, and general anesthesia on the dorsolateral subluxation score in dogs

OBJECTIVE: To determine whether dorsal loading of the pelvis and type of chemical restraint affected the dorsolateral subluxation (DLS) score of dog hips. STYDY DESIGN: In vivo testing of diagnostic method. ANIMALS: Labrador retrievers, Greyhounds, and crosses between both breeds (n = 119 dogs). METHODS: Dorsal load was applied to the hips through a strap that was placed over the hips, and the peak vertical and steady-state vertical, ground-reaction forces exerted on the stifles were measured in the DLS position. The DLS score was measured with their hips under dorsal load and compared with the DLS score without load. For 24 dogs, the DLS score was measured both under chemical restraint (medetomidine) and under general anesthesia. Wilcoxon-signed rank test and paired t test was used to compare effects of dorsal load and restraint method on the left and right DLS hip score, and P <.05 was considered significant. RESULTS: Both stifles together accepted median 15% body weight in the vertical plane in the unloaded steady state. Loading the hips increased the steady-state, vertical ground-reaction force to 34% body weight. At 8 months of age, loading significantly decreased the DLS score from 65% +/- 11% (mean +/- SD) to 60% +/- 12% for left hips and 66% +/- 11% to 63% +/- 13% for right hips. The left hip DLS score was affected by load more consistently than the right hip. In general, loading the hips decreased the DLS score in all breeds by 4% to 6% except for the greyhounds, in which the DLS score was unchanged by dorsal loading. When grouped by their DLS scores, load significantly decreased DLS scores in dogs with unloaded scores greater than 55% (nondysplastic), whereas DLS scores of dogs with unloaded scores between 55% and 45% (dysplastic) and less than 45% did not change significantly with load. Unloaded scores did not change significantly when compared under sedation versus general anesthesia. However, load significantly decreased the DLS score under general anesthesia for the left hip but not for the right hip. CONCLUSIONS: Less than half of the vertical ground-reaction force normally exerted by the hindlegs of a standing dog was sufficient to induce hip subluxation in the DLS position. Although dorsal loading approximately doubled the steady-state, vertical ground-reaction force, the decrease in the DLS score under load was never greater than 6%. Furthermore, the DLS scores of dogs most likely to be dysplastic (based on DLS scores <45%) were not affected by load, whereas load slightly decreased DLS cores of dogs with DLS scores greater than 55%. CLINICAL RELEVANCE: External influences can change the DLS score significantly, but the magnitude of change is unlikely to be of clinical importance, making the method useful as a field screening test for both dysplastic and nondysplastic hips in young dogs.     

Effects of feeding a high omega‐3 fatty acids diet in dogs with naturally occurring osteoarthritis

The aim of this randomized, placebo‐controlled and double‐blinded trial was to compare the effect of a veterinary therapeutic diet (VTD) rich in omega‐3 fatty acids (omega‐3) from fish origin to a regular diet used as control (CTR) over a period of 13 weeks in dogs afflicted by naturally occurring osteoarthritis (OA). Thirty privately owned dogs were selected. Dogs had lameness confirmed by an orthopaedic examination, had stifle/hip OA and had locomotor disability based on the peak of the vertically oriented ground reaction force (PVF) measured using a force platform. At Baseline, all owners were asked to determine 2–5 activities of daily living that were the most impaired. Activities were scores (0–4) in accordance with severity using case‐specific outcome measures (CSOM). The PVF was also measured. Dogs (15/group) were then randomly assigned to receive either the CTR or the VTD. The CSOM was completed twice weekly. The recording of PVF was repeated at Week 7 and 13. The VTD‐fed dogs showed a significantly higher PVF at Week 7 (p < 0.001) and at Week 13 (p < 0.001) when compared to Baseline. From Baseline to Week 13, VTD‐fed dogs had a mean (± SD) change in PVF recording of 3.5 ± 6.8% of body weight (%BW) compared with 0.5 ± 6.1%BW (p = 0.211) in CTR‐fed dogs. This change in primary outcome was consistent with an effect size of 0.5. Conversely, dogs fed the CTR did not show significant change in PVF measurements. At the end of the study, the CSOM was significantly decreased (p = 0.047) only in VTD fed dogs. In lame OA dogs, a VTD that contains high level of omega‐3 from fish origin improved the locomotor disability and the performance in activities of daily living. Such nutritional approach appears interesting for the management of OA.     

Acid-base and hormonal abnormalities in dogs with naturally occurring diabetes mellitus

OBJECTIVE: To examine acid-base and hormonal abnormalities in dogs with diabetes mellitus. DESIGN: Cross-sectional study. ANIMALS: 48 dogs with diabetes mellitus and 17 healthy dogs. PROCEDURES: Blood was collected and serum ketone, glucose, lactate, electrolytes, insulin, glucagon, cortisol, epinephrine, norepinephrine, nonesterified fatty acid, and triglyceride concentrations were measured. Indicators of acid-base status were calculated and compared between groups. RESULTS: Serum ketone and glucose concentrations were significantly higher in diabetic than in healthy dogs, but there was no difference in venous blood pH or base excess between groups. Anion gap and strong ion difference were significantly higher and strong ion gap and serum bicarbonate concentration were significantly lower in the diabetic dogs. There were significant linear relationships between measures of acid-base status and serum ketone concentration, but not between measures of acid-base status and serum lactate concentration. Serum insulin concentration did not differ significantly between groups, but diabetic dogs had a wider range of values. All diabetic dogs with a serum ketone concentration > 1,000 micromol/L had a serum insulin concentration < 5 microU/mL. There were strong relationships between serum ketone concentration and serum glucagon-insulin ratio, serum cortisol concentration, and plasma norepinephrine concentration. Serum beta-hydroxybutyrate concentration, expressed as a percentage of serum ketone concentration, decreased as serum ketone concentration increased. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that ketosis in diabetic dogs was related to the glucagon-insulin ratio with only low concentrations of insulin required to prevent ketosis. Acidosis in ketotic dogs was attributable largely to high serum ketone concentrations.     

Platelet aggregation in dogs after sedation with acepromazine and atropine and during subsequent general anesthesia and surgery.

Platelet aggregation and adenosine triphosphate (ATP) release were measured by use of the impedance method in blood samples obtained from 25 adult female Beagles before and after sedation with acepromazine (0.13 mg/kg of body weight) and atropine (0.05 mg/kg), and during general anesthesia. General anesthesia was induced by IV administration of thiamylal (average dosage, 2.1 mg/kg; range, 1.2 to 4.2 mg/kg) and was maintained with halothane in oxygen. Samples of jugular venous blood were obtained from each dog, using citrate as anticoagulant. Platelet count was done on each sample. Platelet aggregation and ATP released from the aggregating platelets were measured within 2.5 hours of sample collection, using a whole-blood aggregometer. Adenosine diphosphate (ADP) or collagen was used as aggregating agent. For each aggregating agent, platelet aggregation and ATP release were measured over 6 minutes. After sedation with acepromazine and atropine, significant (P < 0.01) reduction was observed in platelet count (from median values of 341,000 cells/microliters to 283,000 cells/microliters) and in the ability of platelets to aggregate in response to ADP (from 14.0 to 7.0 omega). During the same period, maximal release of ATP in response to collagen also was reduced (from 5.56 mumol to 4.57 mumol; P < 0.01); however, this difference ceased to be significant when ATP release was normalized for platelet count. During general anesthesia and surgery (200 minutes after sedation), platelet count and aggregation responses to ADP and collagen had returned to presedation values. None of the dogs in this study appeared to have hemostasis problems during surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Detection of serum alpha-fetoprotein in dogs with naturally occurring malignant neoplasia

Serum alpha-fetoprotein (AFP) concentrations were determined, by use of an automated microparticle enzyme-linked immunoassay (MEIA), in 16 control dogs and 48 dogs with previously untreated, histologically confirmed, naturally occurring neoplasia (17 dogs with lymphoma and 31 dogs with nonhematopoietic malignancies, 13 dogs with carcinomas, 18 dogs with sarcomas). Mean serum AFP concentrations for untreated dogs with lymphoma, for dogs with sarcomas, and for dogs with carcinomas were not significantly different from the mean serum AFP concentration for the 16 untreated control dogs. Mean serum AFP concentration for dogs with transitional cell carcinoma (n=7) was not significantly different from the mean serum AFP concentration for the control dogs. It has been shown previously by others that a mean serum AFP concentration > 225 ng/mL is suggestive of a hepatic malignancy (e.g., hepatocellular carcinoma, lymphoma). In our study, all 48 dogs had a normal complete blood count, serum biochemical analysis, and urinalysis. Only one of the 48 dogs was found to have a serum AFP concentration > 225 ng/mL. Later evaluation of this dog confirmed hepatic involvement with lymphoma. AFP can be detected in the serum of dogs with naturally occurring tumors using the MEIA technique. A serum AFP concentration above that observed in normal dogs is not a common finding in dogs with naturally occurring neoplasia; however, we confirmed that a serum AFP concentration > 225 ng/mL, with or without evidence of a serum biochemical abnormality, may suggest primary and/or secondary hepatic involvement with a neoplastic disease and may warrant an adjustment in clinical stage and prognosis. A prospective diagnostic and therapeutic evaluation of dogs, with naturally occurring tumors having an elevated serum AFP concentration would determine the validity of this conclusion.     

Diagnosis and treatment of naturally occurring hypoadrenocorticism in 42 dogs

Hypoadrenocorticism was diagnosed in 42 dogs over a two-and-a-half-year period. The disease occurred more commonly in young to middle-aged dogs, with a female:male ratio of 2:1. Most dogs had chronic intermittent signs (eg, poor appetite, lethargy and vomiting), but more than a third were in acute adrenal crisis at the time of diagnosis. Serum biochemical testing revealed azotaemia, hyperphosphataemia, hyper-kalaemia and hyponatraemia in almost all the dogs. In all dogs, results of adrenocorticotrophic hormone (ACTH) stimulation testing revealed a low to low-normal serum baseline Cortisol concentration that failed to increase after ACTH administration. In two dogs with persistently normal serum electrolytes concentration, one had a markedly high plasma ACTH concentration diagnostic for primary hypoadrenocorticism, whereas the other had a low concentration confirming secondary hypoadrenocorticism. Fludrocortisone acetate was initially used for mineralocorticoid replacement in 33 of the 37 treated dogs withprimary hypoadrenocorticism (final median dosage, 27-0 μg/kg/day), but supplementation was changed to desoxycorticos-terone pivalate (DOCP) in four dogs because of poor response or adverse effects. Seven dogs with primary hypoadrenocorticism were treated with DOCP (final median dosage, 2-02 mg/kg/month). Prednisone, initially administered to 36 dogs, was discontinued in 11 dogs because of side effects. Of the dogs treated with fludrocortisone, the response was considered good to excellent in 26 dogs (78.8 per cent), fair in three, and poor in four. All dogs treated with DOCP responded well.     

Liver glutathione concentrations in dogs and cats with naturally occurring liver disease

OBJECTIVE: To determine total glutathione (GSH) and glutathione disulfide (GSSG) concentrations in liver tissues from dogs and cats with spontaneous liver disease. SAMPLE POPULATION: Liver biopsy specimens from 63 dogs and 20 cats with liver disease and 12 healthy dogs and 15 healthy cats. PROCEDURE: GSH was measured by use of an enzymatic method; GSSG was measured after 2-vinylpyridine extraction of reduced GSH. Concentrations were expressed by use of wet liver weight and concentration of tissue protein and DNA. RESULTS: Disorders included necroinflammatory liver diseases (24 dogs, 10 cats), extrahepatic bile duct obstruction (8 dogs, 3 cats), vacuolar hepatopathy (16 dogs), hepatic lipidosis (4 cats), portosystemic vascular anomalies (15 dogs), and hepatic lymphosarcoma (3 cats). Significantly higher liver GSH and protein concentrations and a lower tissue DNA concentration and ratio of reduced GSH-to-GSSG were found in healthy cats, compared with healthy dogs. Of 63 dogs and 20 cats with liver disease, 22 and 14 had low liver concentrations of GSH (micromol) per gram of tissue; 10 and 10 had low liver concentrations of GSH (nmol) per milligram of tissue protein; and 26 and 18 had low liver concentrations of GSH (nmol) per microgram of tissue DNA, respectively. Low liver tissue concentrations of GSH were found in cats with necroinflammatory liver disease and hepatic lipidosis. Low liver concentrations of GSH per microgram of tissue DNA were found in dogs with necroinflammatory liver disease and cats with necroinflammatory liver disease, extrahepatic bile duct occlusion, and hepatic lipidosis. CONCLUSIONS AND CLINICAL RELEVANCE: Low GSH values are common in necroinflammatory liver disorders, extrahepatic bile duct occlusion, and feline hepatic lipidosis. Cats may have higher risk than dogs for low liver GSH concentrations.     

Effect of medetomidine administration on bispectral index measurements in dogs during anesthesia with isoflurane

OBJECTIVE: To determine the relationship between bispectral index (BIS) and minimum alveolar concentration (MAC) multiples of isoflurane after IM injection of medetomidine or saline (0.9% NaCl) solution in anesthetized dogs. ANIMALS: 6 dogs. PROCEDURE: Each dog was anesthetized 3 times with isoflurane. First, the MAC of isoflurane for each dog was determined by use of the tail clamp method. Second, anesthetized dogs were randomly assigned to receive an IM injection of medetomidine (8 microg x kg(-1)) or an equal volume of isotonic saline (0.9% NaCl) solution 30 minutes prior to beginning BIS measurements. Last, anesthetized dogs received the remaining treatment (medetomidine or isotonic saline solution). Dogs were anesthetized at each of 4 MAC multiples of isoflurane. Ventilation was controlled and atracurium (0.2 mg/kg followed by 6 microg/kg/min as a continuous infusion, IV) administered. After a 20-minute equilibration period at each MAC multiple of isoflurane, BIS data were collected for 5 minutes and median values of BIS calculated. RESULTS: BIS significantly decreased with increasing MAC multiples of isoflurane over the range of 0.8 to 2.0 MAC. Mean (+/- SD) MAC of isoflurane was 1.3 +/- 0.2%. During isoflurane-saline anesthesia, mean BIS measurements at 0.8, 1.0, 1.5, and 2.0 MAC were 65 +/- 8, 60 +/- 7 52 +/- 3, and 31 +/- 28, respectively. During isoflurane-medetomidine anesthesia, mean BIS measurements at 0.8, 1.0, 1.5, and 2.0 MAC were 77 +/- 4, 53 +/- 7, 31 +/- 24, and 9 +/- 20, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: BIS monitoring in dogs anesthetized with isoflurane has a predictive value in regard to degree of CNS depression. During isoflurane anesthesia, our results support a MAC-reducing effect of medetomidine.     

Procedural sedation combined with locoregional anesthesia for orthopedic surgery of the pelvic limb in 10 dogs: case series

HistoryTen dogs weighing 36 (21.4–75) kg [median (min–max)] and aged 3 (1–9) years scheduled for orthopedic surgery involving the stifle and structures distal to it.Physical ExaminationPatients were classified as ASA I or II based on physical examination and basic hematology and biochemistry.ManagementEach dog was managed using combined femoral and sciatic nerve blocks and procedural sedation with an intravenous infusion of propofol (0.07–0.15 mg kg^?1 minute^?1) and dexmedetomidine (1 μg kg^?1 hour^?1). None of the patients required conversion to general anesthesia as a result of response to surgical stimulation. The level of sedation was considered adequate in all patients and was characterized by occasional head lifting, thoracic limb stretching, yawning, lingual movements and swallowing. The eye position ranged from central to partial ventromedial rotation and was accompanied by spontaneous blinking. Intra-operative cardiovascular and ventilatory variables were considered within acceptable limits. Muscle relaxation at the surgical field was adequate and surgical conditions were indistinguishable from those produced by general anesthesia. Intraoperatively, no additional analgesics were considered necessary. The quality of the recoveries was considered excellent in all cases.Follow upNo additional pain relief was required in any of the dogs within the 10 hours following blockade. All dogs ate 5.5 (3.5–12) hours after recovery. Ambulation occurred at 4 (2–6) hours. No evidence of esophagitis or aspiration pneumonitis has been reported during a period of 1 year after the procedures in any of the dogs.ConclusionWhen combined with femoral and sciatic nerve blocks, procedural sedation has the potential of being an alternative to general anesthesia for orthopedic surgery involving the stifle and structures distal to it in the dog.     

Effects of doxapram HCl on laryngeal function of normal dogs and dogs with naturally occurring laryngeal paralysis

OBJECTIVES: To compare the effects of IV doxapram on glottic size and arytenoid motion in normal dogs and in dogs with laryngeal paralysis. STUDY DESIGN: Prospective experimental and clinical trials. ANIMALS: Six healthy dogs weighing 24.5 +/- 3.9 kg and six dogs weighing 27.4 +/- 11.5 kg suspected of having laryngeal paralysis. METHODS: Dogs were pre-medicated with acepromazine and butorphanol, and a light plane of anesthesia was induced with isoflurane by mask. Videoendoscopic examination of laryngeal function was recorded before (baseline) and after IV doxapram administration. Normalized glottal gap area (NGGA) at maximal inspiration and expiration, and percentage change in height, width, area, and NGGA were calculated with measurements from digitized images of the glottal gap. RESULTS: Active arytenoid motion was present in all normal dogs at baseline. After doxapram administration, depth of respiration appeared greater, but arytenoid motion, as measured by percentage change in NGGA, and in area and width, did not significantly increase in normal dogs. No arytenoid motion was detected in dogs with laryngeal paralysis at baseline; however, rima glottidis NGGA of dogs with laryngeal paralysis was greater at inspiration and expiration than normal dogs. After doxapram administration, dogs with laryngeal paralysis developed paradoxical arytenoid motion and significant, negative percentage change in area (-61%) and NGGA (-145%) because of inward collapse of the arytenoids during inspiration. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of doxapram during laryngeal examination is useful for differentiating normal dogs from dogs with laryngeal paralysis. Dogs with laryngeal paralysis may suffer extreme glottic constriction with vigorous respirations, and may require intubation during examination.     

Prospective trial of metronomic chlorambucil chemotherapy in dogs with naturally occurring cancer

The purpose of this study was to assess the toxicoses and antitumor activity of metronomic chlorambucil at a dosage of 4 mg m(-2) daily in dogs with naturally occurring cancer. Thirty-six dogs were enrolled in the study. The protocol was well tolerated with no grade 3 or 4 toxicoses noted. Complete remission was achieved, and lasted over 35 weeks in three dogs (mast cell tumour, soft tissue sarcoma and thyroid carcinoma). Partial remission was noted in 1 dog with histiocytic sarcoma (39 weeks duration) for an overall remission rate of 11% (4 of 36). Stable disease was noted in 17 dogs (47%) with various other cancers. The median progression-free interval was 61 days, and the median survival time was 153 days. Chlorambucil given in a metronomic protocol showed antitumor activity in dogs with a variety of naturally occurring cancers.     

Evaluation of pacing site in dogs with naturally occurring complete heart block

Objective

To compare left ventricular synchronization and systolic performance with transvenous pacing of the right ventricular apex (RVA), left ventricular free wall (LVF) or simultaneous pacing of the RVA and LVF (BiV).

Animals, materials and methods

Seven canine patients with complete heart block. Prospective study evaluating effect of pacing site. Twenty four hours following implantation of transvenous BiV pacing systems, electrocardiograms and echocardiograms were assessed during pacing from the: (1) Right Atrial Appendage/RVA (RAA/RVA), (2) RAA/LVF, and (3) RAA/BiV.

Results

QRS duration was significantly shorter with BiV pacing versus LVF pacing (p < 0.001), or RVA pacing (p < 0.001). Echocardiographic indices of systolic performance fractional shortening (FS), ejection fraction (EF), cardiac output (CO) were significantly higher with BiV pacing than with pacing from the RVA (P = 0.023, 0.006, and 0.002 respectively). Cardiac output, measured by the biplane Simpson's method, was higher with LVF versus RVA pacing (P = 0.036). There was no difference in FS or EF when comparing LVF to RVA pacing. Tissue Doppler measurements of synchronization and systolic performance did not show any difference between pacing mode, but a significantly increased number of segments were seen to contract following aortic valve closure during LVF pacing (P = 0.0268) and RVA pacing (P = 0.0197) as compared to BiV pacing.

Conclusions

Findings suggest that BiV pacing improves cardiac output and systolic performance versus RVA pacing. This improvement however, is not reflected in tissue Doppler indices of synchronization and systolic performance.